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Today, U.S. News released its 22nd annual Best Hospitals rankings, singling out 720 hospitals out of about 5,000 nationwide. Just 17 earned spots on the Honor Roll—which signifies the highest level of medical excellence—with Johns Hopkins Hospital in Baltimore topping the list. The rankings also identify the Best Hospitals in 94 of the largest U.S. metropolitan areas, a major expansion that covers nearly twice as many cities as in the past. This year's rankings include additional new features, such as the Most Connected Hospitals, or those with the most advanced electronic medical records system. And for the first time, U.S. News has named top doctors at many hospitals, part of a larger upcoming project: Next Tuesday, it will release U.S. News Top Doctors, a directory of nearly 30,000 excellent physicians searchable by location and hospital affiliation, as well as across a wide range of specialties and subspecialties.

Best Hospitals 2011-12: the MethodologyOur intent when we published the first Best Hospitals annual rankings in 1990 was to help people who find themselves in need of unusually skilled inpatient care, and that mission hasn't changed in Year 22. The Best Hospitals rankings judge medical centers on their competence in exactly such high-stakes situations. For example, a hospital ranked in cardiology and heart surgery—one of 16 specialties in which centers were evaluated—likely has the expertise and experience to replace a faulty heart valve in a man in his 90s. Most hospitals would decline to perform major surgery on elderly patients, as they should if they aren't up to speed on the special techniques and precautions required and don't see many such patients. A ranked hospital in gastroenterology can probably offer the most appropriate care to a patient whose inflammatory bowel disease flares up. At hospitals ranked in neurology and neurosurgery, surgeons face more spinal tumors in a couple of weeks than most community hospitals see in a year.

By contrast, other hospital ratings and rankings for the most part examine how well hospitals treat relatively unthreatening conditions or perform fairly routine procedures, such as hernia repair and uncomplicated heart bypass surgery. The majority of hospital patients need such ordinary care, so for them that approach to evaluating hospitals works fine. But it falls short for patients who are especially at risk because of age, physical condition, infirmities, or the challenging nature of the surgery or other care they need.

A good way to determine how well a hospital deals with a medical challenge is to evaluate its performance across a range of challenges within the specialty. U.S. News ranks hospitals in 16 different specialties, from cancer to urology. This year, only 140 of the 4,825 hospitals that we evaluated performed well enough to rank in even one specialty. And of the 140, just 17 qualified for a spot on the Honor Roll by ranking at or near the top in six or more specialties. [Read more: Best Hospitals 2011-12: the Methodology.]

How We Identified More Than 100 Most Connected Hospitals

We live in a digital age. We use electronic systems to connect with others, to entertain ourselves, and to compare the quality of myriad goods and services, including—as users of U.S. News know—hospital care.

Yet inside the walls of many hospitals, doctors and nurses still rely on reams of paper charts and antiquated systems to track patient health, order tests and treatments, and perform other essential duties. While many of these professionals provide quality medical care, they do so without the use of a suite of technologies broadly known as electronic medical records, or EMRs, that could make patients safer and their care more efficient.

By contrast, a relatively small number of hospitals have readily embraced EMRs and use them to connect healthcare providers to one another and to the information each needs to do his or her job.